VA/DoD Publish New Tobacco Use Treatment Guideline

The U.S. Department of Veterans Affairs (VA) and Department of Defense (DoD) have published a new clinical practice guideline (CPG) aimed at helping the nation’s veterans and military service members quit tobacco.

The guideline consists of 32 recommendations across ten topic areas. Key components include:

• The use of motivational interviewing to increase engagement in treatment of tobacco and nicotine use.
• The use of FDA-approved pharmacotherapies, with varenicline recommended over monotherapy with other agents.
• The use of combination nicotine replacement therapy (NRT) over NRT monotherapy.
• Extending the use of bupropion sustained-release beyond 12 weeks.
• The use of varenicline for increasing abstinence from smokeless tobacco and electronic nicotine delivery systems (ENDS).
• The use of NRT or varenicline to increase quit attempts and abstinence in patients not ready to quit in the next 30 days.

The guideline was developed by a multidisciplinary panel that reviewed evidence on tobacco cessation treatments published between 2014 and 2024. In addition to the recommendations, the document suggests several areas that could benefit from further study, including head-to-head trials directly comparing evidence-based pharmacotherapy combinations, research on individual factors predicting superior response to specific medications, new behavioral interventions, and noninferiority trials aimed at identifying new treatment options.

“The 2026 VA/DoD CPG for tobacco use treatment provides comprehensive, evidence-based recommendations for assessing and treating tobacco and nicotine dependence across the continuum of care,” wrote the authors. “Strengths of the guideline include coverage of emerging tobacco and nicotine products, such as ENDS, which represent a departure from most prior guidelines.”

The guideline was published by the Annals of Internal Medicine. 

Highlighted in RC Buzz, October 12, 2026